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Shared mechanisms include hyperglycemia, vitamin D deficiency, and oxidative stress, while advanced imaging supports earlier identification. Management emphasizes glycemic control, calcium and vitamin D, weight-bearing activity, and timely pharmacologic care to protect peak bone mass and reduce lifelong fracture 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\n[https://doi.org/10.6065/apem.2550100.050](https://doi.org/10.6065/apem.2550100.050)[ ](https://doi.org/10.6065/apem.2550100.050)[Ann Pediatr Endocrinol Metab 2025](Ann Pediatr Endocrinol Metab 2025);[30:287-295](30:287-295)  \nBone health in children and adolescents with type 1 and type 2 diabetes  \nYong Jun Choi  \nDepartment of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea  \nReceived: 19 March, 2025  \nRevised: 28 March, 2025  \nAccepted: 26 May, 2025  \nAddress for correspondence:  \nYong Jun Choi  \nDepartment of Endocrinology and Metabolism, Ajou University School of Medicine, 164 Worldcupro, Yeongtong-gu, Suwon 16499, Korea  \nEmail: [colsmile@hanmail.net](colsmile@hanmail.net)  \n[https://orcid.org/0000-0003-3960-](https://orcid.org/0000-0003-3960-)[ ](https://orcid.org/0000-0003-3960-)8470  \nThe increasing prevalence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) among children and adolescents presents major challenges for long term skeletal health. This review explores the effect of diabetes on bone health during critical phases of skeletal development. In T1D, insulin deficiency disrupts the insulin/ insulin like growth factor 1 axis, which is essential for osteoblast function, leading to decreased bone mineral density (BMD), lower bone formation markers, and altered microarchitecture. Conversely, T2D shows a paradoxical trend of normal or elevated BMD despite higher fracture risk, which is attributed to compromised bone quality from advanced glycation end product accumulation and altered microarchitecture. Both types of diabetes share common pathophysiological mechanisms, including hyperglycemia, vitamin D deficiency, and oxidative stress, while also exhibiting distinct characteristics. Modern assessment techniques that go beyond conventional densitometry, such as trabecular bone score and high resolution peripheral quantitative computed tomography, provide valuable insights into diabetes specific bone abnormalities. Effective management strategies highlight the importance of strict glycemic control, adequate calcium and vitamin D supplementation, weight bearing physical activities, and, when necessary, pharmacological interventions. Early identification and intervention are critical, as diabetes related bone impairments during childhood can compromise peak bone mass development, potentially increasing the risk of lifelong fractures. As the prevalence of diabetes continues to rise globally, addressing bone health has become increasingly important for preventing future complications and ensuring good quality of life into adulthood.  \nKeywords: Type 1 diabetes, Type 2 diabetes, Bone mineral density, Skeletal development, Diabetic bone disease  \nHighlights  \n· Type 1 diabetes impairs bone formation through insulin deficiency and disrupted insulin like growth factor 1 signaling, leading to reduced bone mineral density and altered microarchitecture.  \n· Type 2 diabetes paradoxically presents with normal or elevated bone mineral density but increased fracture risk, attributed to compromised bone quality from advanced glycation end product accumulation.  \n· Early identification using advanced imaging techniques (trabecular bone score, high resolution peripheral quantitative computed tomography) combined with comprehensive management strategies is essential to optimize peak bone mass during critical developmental periods.  \nIntroduction  \nThe global burden of diabetes mellitus among children and adolescents has risen  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://](http://)[ ](http://)[creativecommons.org/licenses/by-nc/4.0](creativecommons.org/licenses/by-nc/4.0)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.  \n©2025 Annals of Pediatric Endocrinology & Metabolism  \nISSN: 2287-1012(Print)  \nISSN: 2287-","cbCaiiBfyvoYMNnh","https://ap.wps.com/l/cbCaiiBfyvoYMNnh","pdf",1016177,"English","# Introduction\n## Diabetes burden in youth and skeletal implications\n# Pathophysiology of bone impairment in T1D and T2D\n## Type 1 diabetes mechanisms\n## Type 2 diabetes mechanisms\n# Assessment methods for diabetic bone abnormalities\n## Beyond conventional densitometry\n# Management strategies to protect peak bone mass\n## Glycemic control and supplementation\n## Physical activity and pharmacologic interventions\n# Importance of early identification and intervention","[{\"question\":\"How does type 1 diabetes affect bone health in children and adolescents?\",\"answer\":\"Type 1 diabetes causes insulin deficiency that disrupts the insulin/IGF-1 signaling axis, impairing osteoblast function and resulting in reduced bone mineral density, lower bone formation markers, and altered microarchitecture.\"},{\"question\":\"Why can type 2 diabetes show normal or elevated bone mineral density despite higher fracture risk?\",\"answer\":\"In type 2 diabetes, fracture risk increases even when bone mineral density is normal or elevated because bone quality is compromised, attributed to advanced glycation end product accumulation and altered microarchitecture.\"},{\"question\":\"What assessment and management approaches are recommended to protect peak bone mass?\",\"answer\":\"The review highlights advanced imaging beyond conventional densitometry, such as trabecular bone score and high-resolution peripheral quantitative computed tomography, along with management focused on strict glycemic control, adequate calcium and vitamin D, weight-bearing physical activity, and pharmacologic interventions when needed.\"}]","Bone health in children and adolescents with type 1 and type 2 diabetes | PDF",1790757270,23]